Calling Moms/SN...kids on adhd meds, please reply

[sheryl]

OK, dd is doing well. She's over 2 years seizure free and at last appt a month ago her dr said he'll probably wean her off both epilepsy meds towards late summer/early fall.

 

She's been diagnosed with add, adhd and odd. As a result she's on 2 meds for those: adderall and risperidal. Initially she was on adderall xr at a lower then somewhat higher dose and risp one increase from .25 to .5 dose.

 

The risp is NOT working....so I don't give her those. Makes her groggy and it's terrible. Thanks to hsbaby posting about her creative approach to adderall, my dd now takes regular aderall. The pharmacist said that Aderall xr's "peak" life is around 3 hours, but can stay in the body tapering off for up to 18 hours!!!!!!!!!

 

Now I don't believe Aderall is the med for her. period. I talked to the pharmacist this morning and I asked what alternatives would be worth investigating and he said: straterra, concerta and focilin (sp?). From my earlier research before dd was even started on meds, but we knew it was forthcoming, I found strattera is non habit forming.

 

Question: for those of you using straterra, focilin, concerta....is it working for you dc? Have you ever switched one to another? Are they improving? How long has s/he been on it?

 

PLEASE Present your cases. I need to present mine at the next psychiatrist appt. She will not be pleased....she's all textbook and insists aderall should work. But, each person's body chemistry and processing of a med is different....my dd is not textbook.

 

Thanks. Sheryl <><

[Orthodox6]

Patients switch from one med to another all the time. This is customary attitude of both psychiatrists and patients.

 

We never have tried Strattera because it is slow to build up in the body sufficiently for the patient to discover whether or not it even is going to help. (Takes 4-6 weeks, doctors tell us.)

 

Don't know anything about Focalin beyond its existence.

 

Concerta has been very good for both myself and for one of our children. DS took it for several years for ADD/ADHD. No rebound effect, no diminished appetite, no problems of any kind. (Ritalin was useless for him, as it turned him into a nervous, high-bouncing rubber ball.) He took Adderall for a while, but I don't remember how things went with that med. (Classic ADHD/ADD memory function for me !) Can't have been very "bad", as he took it for a while.

 

Adderall did not work for me, however. I had the daily "crash" and wept without reason. Concerta was a good fit for me.

 

DD tried Concerta very recently and, to our great surprise, had the "crash" effect every day when it wore off. We stopped using it, and currently are back at the drawing board.

 

Perhaps a substitute med for the Risperdal would be helpful, if the ODD elements are active ?

 

My own thoughts are that none of the ADHD meds are habit-forming when used properly. I think that is a scare tactic flung out by people who oppose the appropriate use of medications. I'm not swearing to this in a court of law; just have concluded this from years of our using medications, and from watching other families.

 

At any rate, again I'll encourage you to keep on reading about all the various medications and to stand up against the p-doc when needed. You live with your child, and you see the finer-points of how the meds act in her body.

[LizzyBee]

Adderall was a disaster for my kid. She went from her bubbly self to weepy and sad, and I refused to continue it. Luckily, our dr. completely agreed with us.

 

Concerta was perfect for her. It helped her focus without affecting her mood or changing her personality. We had to discontinue it because she said it made her stomach hurt, but if it weren't for that, I wouldn't hesitate to continue to use it. We used a very low dose so that it improved her focus, but didn't change her need to move a lot. If you try it, be warned that dd was awake until 6 am the first day she took it. But she adjusted to it got back to a normal sleep schedule pretty quickly.

[jolley]

Ds 9 used strattera for a few months and became very aggressive. (neurodevelopmentalist said this is a very common side effect to strattera) Homeschooling him became night and day difference for him. He still needs to be fairly busy though.

 

Ds 6 FAS is on concerta. Awesome stuff! No side effects. He takes it every morning. Food doesn't affect the way its absorbed! So since he's a late riser he can take it with breakfast.

[MariannNOVA]

Lots of stuff to respond to here: our child psychiatrist (we don't see him anymore as the ped manages meds) told us at the outset that prescribing meds is a 'crap shoot' (his words, not mine). He told us there is no way to know what is going to work or not work with a child - he scored first time out for ds with focalin which worked well for more than a year. He bombed first time out with twin sister as focalin was terrible for her and she was finished with it in about five days -- she was then switched to vyvanse which was good for more than a year.

 

Both twins are now on adderall (regular - not XR) as what they were taking became ineffective.

 

As for strattera, I've been told it is a 'dirty drug': (I pasted this for you to read):

A dirty drug is an informal term used in pharmacology to describe drugs that may bind to many different molecular targets or receptors in the body, and so tend to have a wide range of effects and possibly negative side effects. Today, pharmaceutical companies try to make new drugs as selective as possible to minimise binding to antitargets and hence reduce the occurrence of side effects and risk of adverse reactions.

Examples of compounds often cited as "dirty drugs" include chlorpromazine, dextromethorphan and ibogaine, all of which bind to multiple receptors or influence multiple receptor systems. There may be instances of advantages to drugs that exhibit multireceptor activity such as the antiaddictive drug ibogaine that acts within a broad range of neurohormonal systems where activity is also exhibited by drugs commonly associated with addiction including opioids, nicotine, and alcohol.[1][2] Similarly chlorpromazine is primarily used as an antipsychotic, but its strong serotonin receptor blocking effects make it useful for treating serotonergic crisis such as serotonin syndrome. Dextromethorphan for its part is widely used as a cough medication, but its other actions have led to trials for several conditions such as its use as an adjunct to analgesia, and a potential anti-addictive drug, as well as its occasional recreational use as a dissociative.

 

I included that info just b/c dd9 was on strattera for two days -- it was a nightmare -- aggressive behavior, crying, belligerance, she became a totally different child - we discontinued it, and the ped prescribed something else. Someone I know 'in the field' told me that Strattera is a 'dirty drug.' After the Strattera incident, I did call the child psych and ask hinm about it -- he did confirm that he did not like to prescribe it and reminded me that it was not on the list of meds he had given me to consider when we first met with him. And, I do know that some meds work for some folks and are anathema to others so I am not slamming Strattera or saying anything other than 'that' was my experience about it and that is what I know about it.

 

There was a little girl in our neighborhood a few years ago who took Concerta and her parents said it worked wonderfully for her -- it's too bad your doc is not more open minded and responsive to you. I think you are being reasonable and you sound reasonable -- I would have great difficulty dealing with a doc who didn't consider my input.

[sheryl]

Lots of stuff to respond to here: our child psychiatrist (we don't see him anymore as the ped manages meds) told us at the outset that prescribing meds is a 'crap shoot' (his words, not mine). He told us there is no way to know what is going to work or not work with a child - he scored first time out for ds with focalin which worked well for more than a year. He bombed first time out with twin sister as focalin was terrible for her and she was finished with it in about five days -- she was then switched to vyvanse which was good for more than a year.

 

Both twins are now on adderall (regular - not XR) as what they were taking became ineffective.

 

As for strattera, I've been told it is a 'dirty drug': (I pasted this for you to read):

A dirty drug is an informal term used in pharmacology to describe drugs that may bind to many different molecular targets or receptors in the body, and so tend to have a wide range of effects and possibly negative side effects. Today, pharmaceutical companies try to make new drugs as selective as possible to minimise binding to antitargets and hence reduce the occurrence of side effects and risk of adverse reactions.

Examples of compounds often cited as "dirty drugs" include chlorpromazine, dextromethorphan and ibogaine, all of which bind to multiple receptors or influence multiple receptor systems. There may be instances of advantages to drugs that exhibit multireceptor activity such as the antiaddictive drug ibogaine that acts within a broad range of neurohormonal systems where activity is also exhibited by drugs commonly associated with addiction including opioids, nicotine, and alcohol.[1][2] Similarly chlorpromazine is primarily used as an antipsychotic, but its strong serotonin receptor blocking effects make it useful for treating serotonergic crisis such as serotonin syndrome. Dextromethorphan for its part is widely used as a cough medication, but its other actions have led to trials for several conditions such as its use as an adjunct to analgesia, and a potential anti-addictive drug, as well as its occasional recreational use as a dissociative.

 

I included that info just b/c dd9 was on strattera for two days -- it was a nightmare -- aggressive behavior, crying, belligerance, she became a totally different child - we discontinued it, and the ped prescribed something else. Someone I know 'in the field' told me that Strattera is a 'dirty drug.' After the Strattera incident, I did call the child psych and ask hinm about it -- he did confirm that he did not like to prescribe it and reminded me that it was not on the list of meds he had given me to consider when we first met with him. And, I do know that some meds work for some folks and are anathema to others so I am not slamming Strattera or saying anything other than 'that' was my experience about it and that is what I know about it.

 

There was a little girl in our neighborhood a few years ago who took Concerta and her parents said it worked wonderfully for her -- it's too bad your doc is not more open minded and responsive to you. I think you are being reasonable and you sound reasonable -- I would have great difficulty dealing with a doc who didn't consider my input.

 

Hey Marianne!

 

Yes, I do remember you're seeing your regular ped. It was your post citing that fact, that I did get the nerve up to call our ped, but as I posted in a recent thread or maybe in a pm to you, that he doesn't want to be the sole med provider because these are secondary issues to her epilepsy. Now her epilepsy is controlled and once she's weaned...her neurol is talking about this summer/fall, then her ped will be more than happy to prescribe the behav meds. With that said though, come to think about it, I'm wondering if he said he'd be willing to "follow protocol" of continuing on "plan" as outlined by psychiatrist. So, if a med didn't work, I don't know if "he" would be willing to change it....he may send us back to the psychi for re-eval then pick up from there. Does your ped call the shots with meds and changes to meds? I think from what you said s/he does.

 

As far as the dirty med goes....I just don't know anymore. This is so frustrating in one regard. I'm wanting the best for her, but there's always a cost. If the dirty drug is counter-productive for her needs, then no way. So many people on the sn group seem to be going for concerta. I really need to figure this out before our next appt.

 

Concerta and Focalin are extended only. She was UP late, etc. on adderall xr so I'm not sure about C/E xr. But, they are different meds and maybe one will metabolize in her body better than the adderall xr. So much to consider.

 

Thanks. Talk to you later. Sheryl

[MariannNOVA]

Hey Marianne!

 

Yes, I do remember you're seeing your regular ped. It was your post citing that fact, that I did get the nerve up to call our ped, but as I posted in a recent thread or maybe in a pm to you, that he doesn't want to be the sole med provider because these are secondary issues to her epilepsy. Now her epilepsy is controlled and once she's weaned...her neurol is talking about this summer/fall, then her ped will be more than happy to prescribe the behav meds. With that said though, come to think about it, I'm wondering if he said he'd be willing to "follow protocol" of continuing on "plan" as outlined by psychiatrist. So, if a med didn't work, I don't know if "he" would be willing to change it....he may send us back to the psychi for re-eval then pick up from there. Does your ped call the shots with meds and changes to meds? I think from what you said s/he does. Yes, the ped and I call the shots -- she has become accustomed to the fact that my input is to be weighed and considered and we both display mutual respect -- she is always interested in any little tidbit that i have gleaned from here or someplace else and she listens patiently and attentively.

 

As far as the dirty med goes....I just don't know anymore. This is so frustrating in one regard. I'm wanting the best for her, but there's always a cost. If the dirty drug is counter-productive for her needs, then no way. So many people on the sn group seem to be going for concerta. I really need to figure this out before our next appt. You know, if you try something and it isn't a good fit, you discontinue it and try something else. It is frustrating, I agree, but there will be something out there that will work and you keep plugging along until you find it. No one here has mentioned the Daytrona patch -- I spoke with a woman in the doc's office who swears by it. She puts it on her kid's forehead while he is still sleeping in the a.m. and by the time he leaves for school, she removes it and she said they have great results with it. And, if you have heard good things about COncerta, you have nothing to lose by trying it.

 

Concerta and Focalin are extended only. She was UP late, etc. on adderall xr so I'm not sure about C/E xr. But, they are different meds and maybe one will metabolize in her body better than the adderall xr. So much to consider. That's interesting -- dd9 did not do well on Focalin but DS did BUT it was the first thing we ever gave him so it may have been that anything at that point was going to work well - anything was better than nothing. And, yes, it all has to do with how they metabolize the meds and the do that differently with each med. Unfortunately, it IS a crap shoot.

 

Thanks. Talk to you later. Sheryl

 

It is really difficult -- I love it when the meds are working and the couple of times they haven't, I have hated it. You haven't mentioned Vyvanse - we had both twins on that for almost two years with excellent results.

[Cortana]

I agree with others that it is a crap shoot. Ds, 8, is on Strattera right now (he has high-functioning autism w/major adhd symptoms and anxiety). We have maxed out the dosage and are seeing him going right back to behavior issues he had before he ever started meds. We are working with a ped that specializes in kids w/autism and a wonderful mental health therapist to find out what to do next. Most likely we will try adding in generic Adderall in a small dose.

 

We've tried Concerta, Adderall XR, Vyvanse plus a combo of Strattera/Adderall XR and combo Strattera/Vyvanse. The problem we had with stimulants was ds had a big problem with side effects (weight loss, loss of appetite, major change in personality), so we took him off the stimulants. He did good at first on Strattera alone (no side effects), but it's not doing the trick anymore, just not strong enough.

 

Even though the combos were a problem in the past, those combos were with a high dose stimulant/low dose Strattera. We are going to try a low dose Adderall/high dose Strattera. There are a couple other meds the ped wants to try before hitting Risperidal, she feels (as does the mental health therapist) that's a last resort for ds and we agree with her.

 

Due to insurance reasons, we are having to do generic stimulant for the combo. I'm going to bring up Focalin with her next time, I've only recently heard of it. Anything's worth a try at this point in time.:tongue_smilie:

 

Now dh was on Adderall XR for a while and did wonderful with it, except our insurance had a rediculous copay that just kept going up and up and up every few months. Dh is now on generic Ritalin and does well with it. He said he can tell the difference, that the Adderall XR had a longer lasting effect, but the Ritalin does just fine for him. The biggest drawback is he has to take it more often and, of course, it doesn't last as long, but he has adjusted to it and has no side effects.

 

In the end, all you can do is try something, give it some time, see how it works/doesn't work, keep with it or try something different.:001_smile: It's frustrating, but hopefully you'll find the right meds/combo.

[sheryl]

I agree with others that it is a crap shoot. Ds, 8, is on Strattera right now (he has high-functioning autism w/major adhd symptoms and anxiety). We have maxed out the dosage and are seeing him going right back to behavior issues he had before he ever started meds. We are working with a ped that specializes in kids w/autism and a wonderful mental health therapist to find out what to do next. Most likely we will try adding in generic Adderall in a small dose.

 

We've tried Concerta, Adderall XR, Vyvanse plus a combo of Strattera/Adderall XR and combo Strattera/Vyvanse. The problem we had with stimulants was ds had a big problem with side effects (weight loss, loss of appetite, major change in personality), so we took him off the stimulants. He did good at first on Strattera alone (no side effects), but it's not doing the trick anymore, just not strong enough.

 

Even though the combos were a problem in the past, those combos were with a high dose stimulant/low dose Strattera. We are going to try a low dose Adderall/high dose Strattera. There are a couple other meds the ped wants to try before hitting Risperidal, she feels (as does the mental health therapist) that's a last resort for ds and we agree with her.

 

Due to insurance reasons, we are having to do generic stimulant for the combo. I'm going to bring up Focalin with her next time, I've only recently heard of it. Anything's worth a try at this point in time.:tongue_smilie:

 

Now dh was on Adderall XR for a while and did wonderful with it, except our insurance had a rediculous copay that just kept going up and up and up every few months. Dh is now on generic Ritalin and does well with it. He said he can tell the difference, that the Adderall XR had a longer lasting effect, but the Ritalin does just fine for him. The biggest drawback is he has to take it more often and, of course, it doesn't last as long, but he has adjusted to it and has no side effects.

 

In the end, all you can do is try something, give it some time, see how it works/doesn't work, keep with it or try something different.:001_smile: It's frustrating, but hopefully you'll find the right meds/combo.

 

It is really difficult -- I love it when the meds are working and the couple of times they haven't, I have hated it. You haven't mentioned Vyvanse - we had both twins on that for almost two years with excellent results.

 

 

What you've both said is true....thanks for the reminder AGAIN. I really must remember this. My expectations for these meds is way too high and it would behoove me to remember that it is trial and error.

 

Vyvanse? OK...well at this point I'm going to make a list and we'll just go down the list every month until we get it. However, from what everyone is saying, at some point these meds reach a state of tolerance in the body so to speak and loses it's effectiveness. So, one goes back to the drawing board and start over again....to jump start the new result of the new med. The body must just get used to a med and it has to be changed every now and then.

 

Now any prayer warriors out there? I may send up a separate post on this, but truly we need prayer before going in to see the psychi again. I am afraid....that's not a good sign is it? Marianne, you seem right. To find another dr who is more understandable. Honestly ladies, I am asking for prayer...I think our appt is next Tuesday.

 

Thanks again everyone for the responses, but with your patience ;) and insight as well. Sheryl <><

[Cortana]

We will absolutely be praying for you. :001_smile: We know all to well what it's like to work with a dr that doesn't listen/care (we switched peds 18 mos ago when dd was born for this reason).

 

:grouphug:

[Ottakee]

First of all, did they figure out what is "behind" the ODD? ODD is very often a symptom of something else---ADHD, mood disorders, bipolar, OCD, attachment issues, drug/alcohol effects, etc. Knowing where the ODD is coming from might help treat it better.

 

You said the Risperdal was not working with side effects. Another AP might be indicated---esp. if she has mood issues.

 

Have you looked at Dexedrine at all? It is an older med but for some reason, kids with mood issues seem to do better on it.

 

Strattera is one I would personally stay FAR FAR away from. It is an SNRI--related to the SSRI (anti-depressants). It is well known to cause mood, agression, etc. issues in kids with mood issues already. It takes a long time to build up in the body so a bad reaction can take weeks to get over. When we tried it, I was going to give my daughter to anyone that would even consider taking her for 2 weeks of the coming off it stage.

[asta]

They're not called "dirty drugs". They are called multiple (re) uptake agonists, antagonists or inhibitors.

 

Some drugs only hit one receptor in the brain, some hit many. That is simply how they are made. That doesn't make them "dirty", that just makes them what they are. Some drugs hit only one receptor at a low dose, and multiple receptors at a high dose. Again, that is just how they are designed.

 

And, as someone else already pointed out, stimulants, when used properly, are not addictive. Any med, when used habitually, can cause dependence, but that is a completely different thing. Many people (but certainly not all) become tolerant to the effects of stims and have to have their doses raised. Here is a good definition of the differences:

 

I. Addiction

Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and

environmental factors influencing its development and manifestations. It is characterized

by behaviors that include one or more of the following: impaired control over drug use,

compulsive use, continued use despite harm, and craving.

 

II. Physical Dependence

Physical dependence is a state of adaptation that is manifested by a drug class specific

withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction,

decreasing blood level of the drug, and/or administration of an antagonist.

 

III. Tolerance

Tolerance is a state of adaptation in which exposure to a drug induces changes that result in

a diminution of one or more of the drug's effects over time."

 

Source: American Academy of Pain Medicine, American Pain Society and American Society of Addiction Medicine

 

All of that said, Risperdal is the only anti-psychotic approved for use in pediatrics. There is a chance that your doctor could find something else calming that is off-label, but nothing else has been approved.

 

Unfortunately, you really cannot go off of "what worked for my kid" - you really have to simply try things out on your own in this case. Especially since your kid has a history of seizures. Her doses will be smaller, her medication will have to be more closely monitored, and she may have to take immediate release (rather than extended release) versions of things to insure that you can tell immediately if the drug is exciting her brain too much (eg: moving from controlling her ADD to messing up her EEG pattern again).

 

Is your epileptologist on board with her going on ADD meds?

 

 

a

[sheryl]

A and O, responses below...

 

 

They're not called "dirty drugs". They are called multiple (re) uptake agonists, antagonists or inhibitors.

 

Some drugs only hit one receptor in the brain, some hit many. That is simply how they are made. That doesn't make them "dirty", that just makes them what they are. Some drugs hit only one receptor at a low dose, and multiple receptors at a high dose. Again, that is just how they are designed. A, you know, I think this is what the pharmacist was referrring to yesterday. Interesting.

 

And, as someone else already pointed out, stimulants, when used properly, are not addictive. Any med, when used habitually, can cause dependence, but that is a completely different thing. Many people (but certainly not all) become tolerant to the effects of stims and have to have their doses raised. Here is a good definition of the differences:

 

 

 

All of that said, Risperdal is the only anti-psychotic approved for use in pediatrics. There is a chance that your doctor could find something else calming that is off-label, but nothing else has been approved. But see, she doesn't have psychosis....this drug has been terrible for her. I do NOT give it to her anymore. It made her agressive, etc. She's better off ot it.

 

Unfortunately, you really cannot go off of "what worked for my kid" - you really have to simply try things out on your own in this case. Especially since your kid has a history of seizures. Her doses will be smaller, her medication will have to be more closely monitored, and she may have to take immediate release (rather than extended release) versions of things to insure that you can tell immediately if the drug is exciting her brain too much (eg: moving from controlling her ADD to messing up her EEG pattern again). After reading and understanding some of the other posts, I realized I had to switch from aderall xr to reg aderall. The pharmacist said that aderall xr stays in one's system for UP TO 18 hours!!! That's crazy. She never really came "down". I just feel so bad for her. So, that's when I insisted, and posted about it, a new pres from the dr. She finally agreed to let us try something else. But, it came at a price of her making comments and strong references of: "I usually ask parents who want to switch, where did they get their medical degree from?" AND, "I usually don't see families (something like that) if they want to switch all the time". Do I just have a "bad" (need better word here) psychi?

 

Is your epileptologist on board with her going on ADD meds? It was the neurolog that witnessed, during a routine follow up, our dd not complying/obeying and our conversation of issues with her at the time that prompted him to suggest a neuropsychological eval and pscyhiatrist. Her n knows she's was on 2 beh meds. They do not know I've deleted the R and she now only takes reg adder.

 

Is this typical behavior, speaking of behavior, for a psychiatrist?????

 

 

a

 

First of all, did they figure out what is "behind" the ODD? O, Yes, the "behind" issue is one I would love to have a full assessment on. No, it has not been fully determined I don't believe. ODD is very often a symptom of something else---ADHD, mood disorders, bipolar, OCD, attachment issues, drug/alcohol effects, etc. Her psychi said no to bipolar, no to ocd. She did not even mention the others. Only add, adhd and odd. Knowing where the ODD is coming from might help treat it better.

 

You said the Risperdal was not working with side effects. Another AP might be indicated---esp. if she has mood issues. What is AP? She is moody. With that said, she is "leveling" off some...I think part of it is hormonal. Not all of it though.

 

Have you looked at Dexedrine at all? It is an older med but for some reason, kids with mood issues seem to do better on it. NO, I have not checked into this. I think Asta suggested it, and if you didn't A, I've heard it somewhere before. I'll entertain almost anything. I really don't know though if she needs these behav meds. Because she has made such improved progress neurologically speaking, her brain is settling down some and she is leveling off "some" as mentioned above.

 

Strattera is one I would personally stay FAR FAR away from. It is an SNRI--related to the SSRI (anti-depressants). It is well known to cause mood, agression, etc. issues in kids with mood issues already. It takes a long time to build up in the body so a bad reaction can take weeks to get over. When we tried it, I was going to give my daughter to anyone that would even consider taking her for 2 weeks of the coming off it stage.

[asta]

AP = anti-psychotic

AAP = atypical anti-psychotic

 

One of the things you have to wrap your brain around is that, in neuropsychopharmacology, what a drug is called (eg: how it is classified) is pretty much irrelevant to how it is utilized in reality.

 

AED = anti-epileptic drug, but the majority of the world refers to them as "mood stabilizers". Why? Because there are more people using them in psychiatry then there are in neurology.

 

Currently, there is a big push to use AAPs (Risperdal is one) as a mood stabilizer. Unlike AEDs, they do not have a painfully slow titration schedule, and doctors can see results more or less immediately. The doses they use for "mood stabilization" are far beneath the doses that are used to quell psychosis.

 

One thing to remember when worrying that Strattera is an SNRI (which works for depression) - all of the original stimulants were designed not for ADD, but as anti-depressants. And, to this day, stims are still used for treatment-resistant depressives.

 

 

a

[Ottakee]

One thing that might help you is the book, Straight Talk About Psychiatric Meds for kids by Timothy Wilens. Look for the most recent edition. I have an older version but he explains many of the different meds, what they are used for, side effects, combinations of meds, etc.

[sheryl]

One thing that might help you is the book, Straight Talk About Psychiatric Meds for kids by Timothy Wilens. Look for the most recent edition. I have an older version but he explains many of the different meds, what they are used for, side effects, combinations of meds, etc.

 

AP = anti-psychotic

AAP = atypical anti-psychotic

 

One of the things you have to wrap your brain around is that, in neuropsychopharmacology, what a drug is called (eg: how it is classified) is pretty much irrelevant to how it is utilized in reality.

 

AED = anti-epileptic drug, but the majority of the world refers to them as "mood stabilizers". Why? Because there are more people using them in psychiatry then there are in neurology.

 

Currently, there is a big push to use AAPs (Risperdal is one) as a mood stabilizer. Unlike AEDs, they do not have a painfully slow titration schedule, and doctors can see results more or less immediately. The doses they use for "mood stabilization" are far beneath the doses that are used to quell psychosis.

 

One thing to remember when worrying that Strattera is an SNRI (which works for depression) - all of the original stimulants were designed not for ADD, but as anti-depressants. And, to this day, stims are still used for treatment-resistant depressives.

 

 

a

 

 

A/O, thanks. You have both mentioned at one point or another that an "older" med might be worth considering. Ya know, I can see that.

 

I called dd's neurologist yesterday b/c she is just *not* remembering. Maybe my expectations are too high, so I'm mindful of that, but it just seems she has a working memory issue with school, personal, etc. So, I called her n and now they want to up her amb eeg to March instead of waiting until June. My guess is these meds have messed up her processing and memory....to a point. I'm grateful she's been on them b/c they have attributed to her being 2+ years seizure-free.

 

It will be interesting to see if her add, adhd, odd continue after she is weanted from her n meds.

 

O, how do you address the "real" issue "behind" the symptoms? I've heard this before and it's fascinating, but one I don't have the answer to. She is defiant, manipulative, etc, etc. Those are the "manifestations". How do you find the root cause?

[asta]

I called dd's neurologist yesterday b/c she is just *not* remembering. Maybe my expectations are too high, so I'm mindful of that, but it just seems she has a working memory issue with school, personal, etc. So, I called her n and now they want to up her amb eeg to March instead of waiting until June. My guess is these meds have messed up her processing and memory....to a point. I'm grateful she's been on them b/c they have attributed to her being 2+ years seizure-free.

 

The meds don't mess anything up permanently, but all AEDs have cognitive effects while a person is on them. But so do seizures. The difference is, seizures have permanent cognitive effects. With a child, the difficultly is that the cognitive issues from seizures prevent "normal" learning milestones from occurring. What one has to do, then, is a "what sucks less" assessment: are the meds causing so much impairment that the child is unable to learn anything at all vs are the sz doing the same thing. Some people say "well, kid is only having one sz a year, so we'd rather not have the effects of the meds". Other people say "kid has 4 a month w/o the meds, we'll go with the meds". KWIM?

 

It will be interesting to see if her add, adhd, odd continue after she is weanted from her n meds.

 

They usually do, but not always, because...

 

O, how do you address the "real" issue "behind" the symptoms? I've heard this before and it's fascinating, but one I don't have the answer to. She is defiant, manipulative, etc, etc. Those are the "manifestations". How do you find the root cause?

 

Seizures are not a diagnosis in and of themselves. They are a manifestation of something else that is going on. Sometimes it is an aberration of a chromosome. Sometimes a brain insult (eg: any number of injuries, tumors, etc.). Sometimes a disease (eg: MS, organic brain disease, Marburg's MS, etc.). Sometimes they are a side effect from something on the Autistic spectrum (where you also find ADD and ADHD behaviors). Sometimes, no one knows where they come from, they are just there - either due to a chemical misfire or a physical, electrical one (they just figured out that there were two different kinds going on).

 

A good neurologist will spend a *lot* of time on a physical exam, really watching how the kid moves their body and doing basic physical tests (just click on the lessons I-VII), and THEN confirm what they believe to be true with imaging, EEG, etc. The basic exam can tell a doctor a great deal about what is going on with a person's nervous system. All of the fancy imaging stuff we have nowadays is of rather recent invention, but most of the diseases we deal with have been around (and been being treated in some form or another) for quite some time.

 

HTH

 

 

a

[TravelingChris]

I have found that my kids needed different medications at different ages and that what worked for one didn't necessarily work for the other. My one is on Vyvanse 70 and that works well for us. It keeps her well attentioned until about 3 and semi-good until about 6. Then it has worn off completely. She is also on Lexapro for headache prevention and PMDD and that helps her behavior too. My dd is 16.5.

[rhettsmommy]

My ds was on concerta for less than a month (dr. switched from Ritalin).....ds is bipolar/ADHD/anxiety....concerta put him in a terrible depression. We went med free for awhile to clean him out. Now he's on homeopathic lithium (does wonders) and strattera (God send). 40mg strattera (strongest dose) and he's fully functioning....none of the ugly, robotic fog that we had on ritalin or concerta. Good luck.

[sheryl]

My ds was on concerta for less than a month (dr. switched from Ritalin).....ds is bipolar/ADHD/anxiety....concerta put him in a terrible depression. We went med free for awhile to clean him out. Now he's on homeopathic lithium (does wonders) and strattera (God send). 40mg strattera (strongest dose) and he's fully functioning....none of the ugly, robotic fog that we had on ritalin or concerta. Good luck.

 

 

Actually I checked out the Homeopathics at a local health food store. There are also homeopathic websites that are comprehensive....submitting symptoms and homeopathics are recommended bases on the individuals response to the symptom questions. Sulfur is ranked as a natural approach in treating add/adhd. I believe I did see something about lithium as well. This is all interesting.

[WeeBeaks]

We use Strattera successfully here. It was his fifth or sixth drug tried and it worked better than the others for him personally. He is ADHD (or ADD hyperactive type if you prefer I guess they call it now) with some anxiety as well. He also takes Tenex, which is actually a blood pressure medication, and serves to help his hyperactivity and impulsivity specifically, off label. We have Risperdal but usually do not use it as it is too sedating. He occasionally crashes due to various reasons (usually related to viral illness) where he is uncontrollable, and we do use short-term emergency Risperdal then. Our particular psych feels Risperdal is a rescue med not a maintenance med for most kids. I'm sure other opinions vary - just sharing one opinion there. What we have is working most of the time for us, at least in the home education situation. It honestly would probably not be strong enough for a classroom environment requiring more sitting/less movement. We do a lot of behavioral therapies with him, both with the psychiatrist (he is old school and does his own hour long therapy every two weeks as well), and using suggestions at home.

 

So, that is what worked for us. We are fortunate in this, our second child psychiatrist, to find a very caring and open individual who asks us a lot of questions and listens well. If you have the opportunity and your psych is not at all receptive to your opinions, it may be worth it to seek a second opinion. It does seem like most psychiatric medications are somewhat of a trial and error for patients and not as simple as say an antibiotic. People react differently, and it can change over time in kids especially.

[sheryl]

We use Strattera successfully here. It was his fifth or sixth drug tried and it worked better than the others for him personally. He is ADHD (or ADD hyperactive type if you prefer I guess they call it now) with some anxiety as well. He also takes Tenex, which is actually a blood pressure medication, and serves to help his hyperactivity and impulsivity specifically, off label. We have Risperdal but usually do not use it as it is too sedating. He occasionally crashes due to various reasons (usually related to viral illness) where he is uncontrollable, and we do use short-term emergency Risperdal then. Our particular psych feels Risperdal is a rescue med not a maintenance med for most kids. I'm sure other opinions vary - just sharing one opinion there. What we have is working most of the time for us, at least in the home education situation. It honestly would probably not be strong enough for a classroom environment requiring more sitting/less movement. We do a lot of behavioral therapies with him, both with the psychiatrist (he is old school and does his own hour long therapy every two weeks as well), and using suggestions at home.

 

So, that is what worked for us. We are fortunate in this, our second child psychiatrist, to find a very caring and open individual who asks us a lot of questions and listens well. If you have the opportunity and your psych is not at all receptive to your opinions, it may be worth it to seek a second opinion. It does seem like most psychiatric medications are somewhat of a trial and error for patients and not as simple as say an antibiotic. People react differently, and it can change over time in kids especially.

 

 

Right Tanya, I'm finding myself more and more leaning towards switching psychiatrists. I just like this woman....she's a wonderful woman who attends our church, and I don't question her desire to help us. But, I'm surprised she's so locked in "textbook" mode. Like everything has to work the same for every patient. Some of the responses on my 2 threads have mirrored each other....perhaps seek a different doctor. The one we have is mature and experienced. Now, I like that alot, but perhaps she's too set in her ways. Perhaps a younger doctor would "think outside the box" more. I agree with you. Now I need to find 48 hours in my day....know where I can find that. :D She's even strongly suggesting we get a 2nd opinion. I think that's her polite way of saying she's not interested in future practice with us b/c there are some differences of opinion. Thanks.

[ondreeuh]

My son and daughter both take Concerta. It has ONLY been beneficial for both - neither have any side effects, like tics or slow growth. It does take at least an hour to really take effect, and with my son I start noticing its dropoff at 10-12 hours because his hyperactivity rears back up. My son does take Clonidine to help him sleep at night but I think that's unrelated to the Concerta - at least my daughter has no trouble sleeping.

 

My son is extremely ADHD and the meds completely change him - for the better. He is a wonderful, patient, kind, smart, generous child. Without meds, that is masked by a whirling body and a mind that can't follow a conversation. My dd is ADD only and the effect is more subtle, but still dramatic.

 

My son was on Focalin (regular) for a year or two before we switched to Concerta. The Focalin gave him about 4 hours, so he needed a dose at lunch. The Focalin XR was a total bust - it seemed to peak early (5 hours?) and then ds was a mess in the afternoon.

 

My *only* concern with Concerta is that my son is at the max dosage he can be on (54 mg.) and could probably benefit from a little more help. My dd is 2x his weight and takes 36 mg. and that is fine for her - it is so individual.

[forevergrace]

Sherly,

I hope this helps. Talking about adhd and meds. often leads to many opinion. They work when they are needed. Good luck. Notice that the underlying cause maybe a related to a dopamine receptor. I thought that was really interesting.

Forevergrace

 

"Ritalin boosts learning by increasing brain plasticity"

http://www.eurekalert.org/pub_releases/2010-03/uoc--rbl030510.php

[sheryl]

Sherly,

I hope this helps. Talking about adhd and meds. often leads to many opinion. They work when they are needed. Good luck. Notice that the underlying cause maybe a related to a dopamine receptor. I thought that was really interesting.

Forevergrace

 

"Ritalin boosts learning by increasing brain plasticity"

http://www.eurekalert.org/pub_releases/2010-03/uoc--rbl030510.php

 

 

Yes, thanks. My dd's dr did make reference to something along these lines. I'll read the article. Much appreciated. Sheryl <><

[Jen in DE]

My two daughters and husband all started out with adderall xr and then just regular. It was horrible for us. All three of them lost weight and became depressed. My oldest had daily breakdowns.

 

My younger daughter has inattentive ADHD and takes focalin XR. It has been a lifesaver. She can eat and is able to focus. She doesn't seem to have a crash time. It is the perfect solution for her.

 

Focalin XR was a disaster for DH and for my oldest daughter. Perhaps because they have hyperactive ADHD or just different body chemistry? DH ended up with Concerta. My oldest is just exercising a lot because nothing seems to work for her.

 

Meds can be so tricky and are so individual. I would stay away from adderall due to all the effects.

[sheryl]

My two daughters and husband all started out with adderall xr and then just regular. It was horrible for us. All three of them lost weight and became depressed. My oldest had daily breakdowns.

 

My younger daughter has inattentive ADHD and takes focalin XR. It has been a lifesaver. She can eat and is able to focus. She doesn't seem to have a crash time. It is the perfect solution for her.

 

Focalin XR was a disaster for DH and for my oldest daughter. Perhaps because they have hyperactive ADHD or just different body chemistry? DH ended up with Concerta. My oldest is just exercising a lot because nothing seems to work for her.

 

Meds can be so tricky and are so individual. I would stay away from adderall due to all the effects.

 

 

Jen, What kind of test was given to determine the type as stated above? I thought ADHD was defined as both inattention (lack of focus) and hyperactivity (spinning/hyper). This is interesting.

[cillakat]

I would stay away from adderall due to all the effects.

 

I love adderall. While regular adderall can be tricky b/c of the rapid onset, it was really for me, very very close to my current med Vyvanse. The vyvanse is a little more smooth but it's really, for me, so so close. So close that I should probably switch back since the adderall is $15 a month and vyvanse is $45/mo.

 

:)

K

[cillakat]

I thought ADHD was defined as both inattention (lack of focus) and hyperactivity (spinning/hyper). This is interesting.

 

The current DSM-IV defines three types of ADHD.

 

ADHD - hyperactive type

ADHD - inattentive type

ADHD - combined type

 

http://web4health.info/it/adhd-def-inattentive.htm

[sheryl]

The current DSM-IV defines three types of ADHD.

 

ADHD - hyperactive type

ADHD - inattentive type

ADHD - combined type

 

http://web4health.info/it/adhd-def-inattentive.htm

 

Thanks for that K!

 

Sheryl